344 ON THE PRINCIPLES OF ANTISEPTIC SURGERY 



research ^ that the pyogenic organisms are by no means abundant constituents 

 of the dust of hospitals ; but their rarity can hardly explain the entire absence 

 of suppuration in our wounds for so long a period, and the fact can, I think, 

 only be explained by the co-operation of the natural antisepsis. 



It would, however, be a mistake to suppose that no good can ever be done 

 by corrosive sublimate used in the manner which I have described. Resisting 

 as the staphylococci have shown themselves to that agent, there are other 

 microbes very mischievous to wounds, such as the Streptococcus pyogenes, the 

 streptococcus of erysipelas and the sporeless Bacillus pyocyaneus, which are 

 destroyed by verj- much weaker solutions.- And it may be well that if, as once 

 occurred in my experience, a careless nurse were to come fresh from fomenting 

 a bad case of erysipelas and, without changing her dress, to hand sponges at 

 an operation, the washing with i to 500 sublimate lotion might avert a calamitous 

 attack of that disease. 



But if, for the sake of guarding against carelessness on the part of our assis- 

 tants we think it prudent to wash our wounds before stitching them, it will, 

 I believe, be wise for us, in the present state of our knowledge, to revert to that 

 which we trusted in former years, the i to 40 solution of carbolic acid. This 

 agent has been shown to be far more uniform in its action upon micrococci than 

 corrosive sublimate. Behring found that even the staphylococci are killed in a 

 minute by a solution of about the strength mentioned,^ while, at the same 

 time carbolic acid is not hindered in its action by albuminoid substances in at 

 all the same degree as sublimate is. The i to 40 solution, while it appears 

 adequate for the purpose, is far less irritating than the i to 20 lotion, and there- 

 fore induces less discharge and involves less necessity for drainage. But here, 

 as in other cases, prevention is better than cure ; and it must ever be borne in 

 mind that nothing that the surgeon can do can make up for want of care in his 

 assistants. If, for example, a pair of forceps is handed to the operator with the 

 intervals between its teeth occupied by dry septic pus, and a portion of this 

 dirt becomes detached and left in the wound, the evil cannot be corrected bv 

 any antiseptic wash that is now at our disposal or any that the world is likely 

 ever to see. Hence I must repeat that our chief attention must be devoted to 

 enforcing scrupulous care on the part of all concerned in the operation in 

 guarding against the grosser forms of septic impurity. Towels dipped in an 



^ Vide Cheyne, op. cit., p. 88. 



^ My colleague Professor Crookshank has ascertained that a cultivation of the streptococcus of 

 erysipelas in bouillon is killed by a solution of sublimate in 4,000 parts of water acting for one 

 minute. 



^ Vide Behring, op. cit., p. 417. Crookshank finds that Staphylococcus pyogenes aureus is killed in 

 one minute by i to 50 watery solution of carbolic acid. 



